Predicting compensation and medical costs of lumbar fusion patients receiving workers' compensation in Utah using presurgical biopsychosocial variables

摘要

STUDY DESIGN.: A retrospective-cohort investigation (N = 245) utilizing a review of patient medical records and costs accrued through the Workers' Compensation Fund of Utah. OBJECTIVE.: To replicate a previous study of compensation and medical costs in compensated lumbar fusion patients, to identify changes in costs across time, and to identify biopsychosocial variables predictive of current costs. SUMMARY OF BACKGROUND DATA.: Previous studies have demonstrated that medical costs associated with lumbar fusion have been rising drastically. It is unclear whether rising fusion costs are occurring in compensation populations. Prior studies have also demonstrated that costs can be predicted on the basis of presurgical biopsychosocial variables, and there is a need to determine whether such variables are still relevant. METHODS.: A retrospective review of patient medical records and compensation and medical costs paid by the Workers' Compensation Fund of Utah was performed. RESULTS.: Since the mid-1990s, medical costs for compensated lumbar fusion patients in Utah have risen approximately 174%, whereas compensation costs have increased roughly with the pace of inflation. Wage and assignment to nurse case management predicted compensation costs, whereas assignment to nurse case management also predicted medical costs. CONCLUSION.: Medical costs among compensated Utah patients receiving lumbar fusion have risen dramatically since the 1990s, whereas compensation costs have not. Biopsychosocial variables continue to be predictive of these costs, although to a more modest degree than in prior studies. Further investigations should look at other factors leading to increased medical costs.